Provider Demographics
NPI:1265462071
Name:MEMPHIS SURGERY ASSOCIATES, PC
Entity Type:Organization
Organization Name:MEMPHIS SURGERY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES./CEO
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:RANDOLPH
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-726-1056
Mailing Address - Street 1:6029 WALNUT GROVE RD
Mailing Address - Street 2:SUITE 404
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2112
Mailing Address - Country:US
Mailing Address - Phone:901-726-1056
Mailing Address - Fax:901-726-5867
Practice Address - Street 1:2996 KATE BOND RD
Practice Address - Street 2:SUITE 309
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38133-4030
Practice Address - Country:US
Practice Address - Phone:901-726-1056
Practice Address - Fax:901-726-5867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNCE0722OtherRAILROAD MEDICARE
TN3703067Medicaid
TN3703067Medicaid